The DA 7574 Forms is a set of three publications released by the U.S. Department of the Army (DA) related to the proper documentation and determination of an injured or ill service member‘s eligibility to receive incapacitation payments.
Fillable versions of the DA 7574 Forms are available for download below. The series includes three forms in total:
A service member has the right to file an incapacitation pay claim if a disease, illness, or injury results in an inability to fulfill either military duties or civilian employment and causes a loss or decrease of non-military earnings. The injury or illness has to be incurred during either active or inactive duty. To be determined as eligible for receiving incapacitation pay, the service member will need to complete DA Form 7574, DA Form 7574-1, and DA Form 7574-2. The filed and signed claim is certified by physicians, commanders, and employers and is submitted through the chain of command for further review.
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This form is for claiming incapacitation pay and providing the information necessary to determine the service member's eligibility to receive it.
Fill this form out if you are a military physician in order to provide conclusions regarding either the ability or inability of a service member to perform their duties.
Fill out this form if you are a service member in order to testify that you received proper incapacitation pay counseling.